Dataset Information

Reduced COPD Exacerbation Risk Correlates With Improved FEV₁: A Meta-Regression Analysis.

ABSTRACT:

Background

The mechanism by which various classes of medication reduce COPD exacerbation risk remains unknown. We hypothesized a correlation between reduced exacerbation risk and improvement in airway patency as measured according to FEV₁.

Methods

By systematic review, COPD trials were identified that reported therapeutic changes in predose FEV₁ (dFEV₁) and occurrence of moderate to severe exacerbations. Using meta-regression analysis, a model was generated with dFEV₁ as the moderator variable and the absolute difference in exacerbation rate (RD), ratio of exacerbation rates (RRs), or hazard ratio (HR) as dependent variables.

Results

The analysis of RD and RR included 119,227 patients, and the HR analysis included 73,475 patients. For every 100-mL change in predose FEV₁, the HR decreased by 21% (95% CI, 17-26; P < .001; R² = 0.85) and the absolute exacerbation rate decreased by 0.06 per patient per year (95% CI, 0.02-0.11; P = .009; R² = 0.05), which corresponded to an RR of 0.86 (95% CI, 0.81-0.91; P < .001; R² = 0.20). The relationship with exacerbation risk remained statistically significant across multiple subgroup analyses.

Conclusions

A significant correlation between increased FEV₁ and lower COPD exacerbation risk suggests that airway patency is an important mechanism responsible for this effect.

SUBMITTER: Zider AD

PROVIDER: S-EPMC6026240 | biostudies-literature | 2017 Sep

REPOSITORIES: biostudies-literature

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Publications

Reduced COPD Exacerbation Risk Correlates With Improved FEV<sub>1</sub>: A Meta-Regression Analysis.

Zider Alexander D AD Wang Xiaoyan X Buhr Russell G RG Sirichana Worawan W Barjaktarevic Igor Z IZ Cooper Christopher B CB

Chest 20170505 3

<h4>Background</h4>The mechanism by which various classes of medication reduce COPD exacerbation risk remains unknown. We hypothesized a correlation between reduced exacerbation risk and improvement in airway patency as measured according to FEV<sub>1</sub>.<h4>Methods</h4>By systematic review, COPD trials were identified that reported therapeutic changes in predose FEV<sub>1</sub> (dFEV<sub>1</sub>) and occurrence of moderate to severe exacerbations. Using meta-regression analysis, a model was ...[more]

PMID: 28483609

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Project description:BackgroundSmall airways are known to be affected early in the course of COPD; however, traditional spirometric indices may not accurately identify small airways disease.Research questionCan forced expiratory volume in 3 s/forced expiratory volume in 6 s (FEV3/FEV6) identify early airflow abnormalities and predict future clinically important respiratory-related outcomes, including development of COPD?Study design and methodsThe study included 832 current and former smokers with post-bronchodilator FEV1/FVC ≥ 0.7 from the Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS) cohort. Participants were classified as having a reduced pre-bronchodilator FEV3/FEV6 based on lower limit of normal (LLN) values. Repeatability analysis was performed for FEV3 and FEV6. Regression modeling was used to evaluate the relationship between baseline FEV3/FEV6 and outcome measures, including functional small airways disease, on thoracic imaging and respiratory exacerbations. Interval-censored analysis was used to assess progression to COPD.ResultsFEV3/FEV6 less than the LLN at baseline, defined as reduced compared with FEV3/FEV6 at or above the LLN, was associated with lower FEV1, poorer health status (St. George's Respiratory Questionnaire score), more emphysema, and more functional small airways disease on quantitative imaging. FEV3 and FEV6 showed excellent agreement between repeat measurements. A reduced FEV3/FEV6 was associated with increased odds of a severe respiratory exacerbation within the first year of follow-up and decreased time to first exacerbation. A low FEV3/FEV6 was also associated with development of COPD according to spirometry results (post-bronchodilator FEV1/FVC < 0.7) during study follow-up.InterpretationFEV3/FEV6 is a routinely available and repeatable spirometric index that can be useful in the evaluation of early airflow obstruction in current and former smokers without COPD. A reduced FEV3/FEV6 can identify those at risk for future development of COPD and respiratory exacerbations.Clinical trial registrationClinicalTrials.gov; No.: NCT01969344; URL: www.Clinicaltrialsgov: ClinicalTrials.gov.

Dataset Information

Reduced COPD Exacerbation Risk Correlates With Improved FEV₁: A Meta-Regression Analysis.

Background

Methods

Results

Conclusions

Publications

Reduced COPD Exacerbation Risk Correlates With Improved FEV<sub>1</sub>: A Meta-Regression Analysis.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets

Dataset Information

Reduced COPD Exacerbation Risk Correlates With Improved FEV1: A Meta-Regression Analysis.

Background

Methods

Results

Conclusions

Publications

Reduced COPD Exacerbation Risk Correlates With Improved FEV&lt;sub&gt;1&lt;/sub&gt;: A Meta-Regression Analysis.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets

Reduced COPD Exacerbation Risk Correlates With Improved FEV₁: A Meta-Regression Analysis.

Reduced COPD Exacerbation Risk Correlates With Improved FEV<sub>1</sub>: A Meta-Regression Analysis.